Provider Demographics
NPI:1063873057
Name:KVDERM, PLLC
Entity type:Organization
Organization Name:KVDERM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-947-7725
Mailing Address - Street 1:7331 E OSBORN DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6435
Mailing Address - Country:US
Mailing Address - Phone:480-947-7725
Mailing Address - Fax:
Practice Address - Street 1:7331 E OSBORN DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6435
Practice Address - Country:US
Practice Address - Phone:480-947-7725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3348207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty